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Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition

Journal of Perinatology volume 35, pages 712–715 (2015)Cite this article

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Abstract

Objective:

To report the prevalence of hypophosphatemia during the first week of life in preterm infants receiving aggressive parenteral nutrition and to analyze population variables associated with severe hypophosphatemia.

Study design:

A retrospective cohort of 61 neonates below 1250 g birth weight consecutively born at Hospital Italiano de Buenos Aires exposed to high caloric and protein intake from the first day of birth. Primary outcome was hypophosphatemia (phosphate <4 mg dl−1). A one-sample mean comparison test was used to compare our sample with a hypothesized population mean.

Results:

The prevalence of hypophosphatemia was 91% (95% confidence interval (CI) 82 to 97%). The mean phosphatemia value was 2.52 mg dl−1 (95% CI 2.18 to 2.86), significantly different from the hypothesized population mean (P<0.001). Patients with severe hypophosphatemia (<2 mg dl−1) were smaller. They presented with sepsis more frequently and received more vasoactive drugs and mechanical ventilation.

Conclusion:

The prevalence of hypophosphatemia in this group of preterm infants is high. The potential association with adverse clinical outcomes deserves further research.

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References

  1. Clark R, Thomas P, Peabody J . Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003; 111: 986–990.

    Article  Google Scholar 

  2. Sakurai M, Itabashi K, Sato Y, Hibino S, Mizuno K . Extrauterine growth restriction in preterm infants of gestational age ≤32 weeks. Pediatr Int 2008; 50: 70–75.

    Article  Google Scholar 

  3. Valentine C, Fernandez S, Rogers LK, Gulaty P, Hayes J, Lore P et al. Early amino-acid administration improves preterm infant weight. J Perinatol 2009; 29: 428–432.

    Article  CAS  Google Scholar 

  4. Dinerstein A, Nieto RM, Solana CL, Pérez GP, Otheguy LE, Larguia AM . Early and aggressive nuritional strategy (enteral and parenteral) decreases posnatal growth failure in very low birth weight infants. J Perinatol 2006; 26: 436–442.

    Article  CAS  Google Scholar 

  5. Ibrahim H, Jeroudi M, Baier RJ, Dhanireddy R, Krouskop R . Aggressive early total parenteral nutrition in low birth weight infants. J Perinatol 2004; 24: 482–486.

    Article  Google Scholar 

  6. Lucas A, Morley R, Cole TJ, Gore SM, Lucas PJ, Crowle P et al. Early diet in preterm babies and development status at 18 months. Lancet 1990; 335: 1477–1481.

    Article  CAS  Google Scholar 

  7. Lucas A, Morley R, Cole TJ . Randomized trial of early diet in preterm babies and later intelligence quotient. BMJ 1998; 317: 1481–1487.

    Article  CAS  Google Scholar 

  8. ElHassan NH, Kaiser JR . Parenteral Nutrition in the Neonatal Inensive Care Unit. Neoreviews 2011; 12: e130–e140.

    Article  Google Scholar 

  9. Ichikawa G, Watabe Y, Suzumura H, Sairenchi T, Muto T, Arisaka O . Hypophosphatemia in small for gestational age extremely low birth weight infants receiving parenteral nutrition in the first week after birth. J Pediatr Endocrinol Metab 2012; 25: 317–321.

    Article  CAS  Google Scholar 

  10. Bonsante F, Iacobelli S, Latorre G, Rigo J, De Felice C, Robillard PY . Initial amino acid ntake influences phosphorus and calcium homeostasis in preterm infants. It is time to change the composition of the early parenteral nutrition. PLoS One 2013; 8: e72880.

    Article  CAS  Google Scholar 

  11. Jamin A, D’Inca R, Le Floc’h N, Kuster A, Orsoneau JL, Darmaun D et al. Fatal effects of a Neonatal high-protein diet in low-birth-weight piglets used as a model of intrauterine growth restriction. Neonatology 2010; 97: 321–328.

    Article  CAS  Google Scholar 

  12. Moltu SJ, Strommen K, Blakstad EW, Almaas AN, Westerberg AC, Braekke K et al. Enhanced feeding in very-low-birth-weight infants may cause electrolyte disturbances and septicemia—a randomized controlled trial. Clin Nutr 2013; 32: 207–212.

    Article  CAS  Google Scholar 

  13. Mizumoto H, Mikami M, Oda H, Hata D . Refeeding syndrome in a small-for-dates micro-preemie receiving early parenteral nutrition. Pediatr Int 2012; 54: 715–717.

    Article  Google Scholar 

  14. Pediatric Nutrition Practice GuideParenteral nutrition. In: Groh-Wargo S, Thompson M, Cox JH (eds). ADA Pocket Guide to Neonatal Nutrition. Precept Press Inc.: Chicago, IL, USA, 2009 pp 29–63.

    Google Scholar 

  15. Parikh MJ, Dumas G, Silvestri A, Bistrian B, Driscoll D . Physical compatibility of neonatal total parenteral nutrient admixtures containing calcium and inorganic phosphate salts. Am J Health Syst Pharm 2005; 62: 1177–1183.

    Article  CAS  Google Scholar 

  16. Manary MJ, Hart CA, Whyte MP . Severe hypophosphatemia in children with kwashiorkor is associated with increased mortality. J Pediatr 1998; 133: 789–791.

    Article  CAS  Google Scholar 

  17. Craddock PR, Yawata Y, Van Santen L, Gilberstadt S, Silvis S, Jacob HS . Acquired phagocyte dysfunction. A complication of the hypophosphatemia of parenteral hyperalimentation. N Engl J Med 1974; 290: 1403–1407.

    Article  CAS  Google Scholar 

Download references

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Author notes

  1. C A Fustiñana: Deceased.

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    P H Brener Dik, M F Galletti, S A Fernández Jonusas, G L Mariani & C A Fustiñana

  2. Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    G Alonso

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  1. P H Brener Dik
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  2. M F Galletti
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  4. G Alonso
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  5. G L Mariani
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  6. C A Fustiñana
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Corresponding author

Correspondence to P H Brener Dik.

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The authors declare no conflict of interest.

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Brener Dik, P., Galletti, M., Fernández Jonusas, S. et al. Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition. J Perinatol 35, 712–715 (2015). https://doi.org/10.1038/jp.2015.54

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